Bladder pain syndrome (BPS)/interstitial cystitis (IC) is a chronic pain syndrome characterized by pain, pressure or discomfort perceived to be bladder related with at least one urinary symptom. The impact of BPS/IC on quality of life and economic burden are enormous. Over the life of this grant, we have hypothesized that pain associated with BPS/IC involves an alteration of visceral sensation/bladder sensory physiology. Changes in visceral sensation may be mediated, in part, by inflammatory changes in the urinary bladder including nerve growth factor (NGF). Monoclonal antibody treatment that specifically inhibits NGF in patients with BPS/IC demonstrates proof of concept; however, clinical trials have halted enrollment due to severe side effects. The need for additional targets beyond NGF is clear. With this competitive renewal application, we propose aims that will provide mechanistic insight into additional NGF-mediated pleiotropic changes that contribute to urinary bladder hyperreflexia and pelvic hypersensitivity in a novel transgenic mouse model of chronic NGF overexpression (NGF-OE) using the urothelium-specific uroplakin II promoter that was characterized during the last funding cycle. The working hypothesis is that increases in urinary frequency and altered sensation that accompany BPS/IC are due to an alteration in the expression, function and interactions of neurochemical mediators and the sensory transducer, transient receptor potential (TRPV) family member TRPV4, in the sensory limb of the urinary bladder reflex. These studies examine the contributions of and interactions between the neuropeptide, PACAP, and receptor PAC1 and TRPV4 to increased voiding frequency and somatic sensitivity in NGF-OE mice. Aim 1: We hypothesize that NGF overexpression exhibited in urothelium and lumbosacral dorsal root ganglia (DRG) of the NGF-OE mouse model induces upregulation of the sensory transducer, TRPV4, in bladder afferent cells in DRG and in urothelial cells of the urinary bladder. We hypothesize that tissue-specific expression of TRPV4, in sensory components (urothelium, DRG) of the micturition reflex contributes to urinary bladder hyperreflexia and pelvic hypersensitivity in NGF-OE mice. Aim 2: We hypothesize that interactions between TRPV4 and PACAP/PAC1 may represent a novel mechanism by which PACAP/PAC1 signaling activates phospholipase C and inositol triphosphate to sensitize TRPV4-mediated changes in voiding behavior and painful sensation. Furthermore, we hypothesize that PAC1 and TRPV4 are co-expressed in bladder afferent DRG and urothelial cells. We will use a multidisciplinary approach including anatomical, biochemical, molecular, electrophysiological, and functional methodologies and a novel ex vivo peripheral nerve recording approach to address these aims. Results will provide key insights into new targets with therapeutic potential to improve urinary bladder function and visceral sensation.